61 Medizin und Gesundheit
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Background: High numbers of consumable medical materials (eg, sterile needles and swabs) are used during the daily routine of intensive care units (ICUs) worldwide. Although medical consumables largely contribute to total ICU hospital expenditure, many hospitals do not track the individual use of materials. Current tracking solutions meeting the specific requirements of the medical environment, like barcodes or radio frequency identification, require specialized material preparation and high infrastructure investment. This impedes the accurate prediction of consumption, leads to high storage maintenance costs caused by large inventories, and hinders scientific work due to inaccurate documentation. Thus, new cost-effective and contactless methods for object detection are urgently needed.
Objective: The goal of this work was to develop and evaluate a contactless visual recognition system for tracking medical consumable materials in ICUs using a deep learning approach on a distributed client-server architecture.
Methods: We developed Consumabot, a novel client-server optical recognition system for medical consumables, based on the convolutional neural network model MobileNet implemented in Tensorflow. The software was designed to run on single-board computer platforms as a detection unit. The system was trained to recognize 20 different materials in the ICU, while 100 sample images of each consumable material were provided. We assessed the top-1 recognition rates in the context of different real-world ICU settings: materials presented to the system without visual obstruction, 50% covered materials, and scenarios of multiple items. We further performed an analysis of variance with repeated measures to quantify the effect of adverse real-world circumstances.
Results: Consumabot reached a >99% reliability of recognition after about 60 steps of training and 150 steps of validation. A desirable low cross entropy of <0.03 was reached for the training set after about 100 iteration steps and after 170 steps for the validation set. The system showed a high top-1 mean recognition accuracy in a real-world scenario of 0.85 (SD 0.11) for objects presented to the system without visual obstruction. Recognition accuracy was lower, but still acceptable, in scenarios where the objects were 50% covered (P<.001; mean recognition accuracy 0.71; SD 0.13) or multiple objects of the target group were present (P=.01; mean recognition accuracy 0.78; SD 0.11), compared to a nonobstructed view. The approach met the criteria of absence of explicit labeling (eg, barcodes, radio frequency labeling) while maintaining a high standard for quality and hygiene with minimal consumption of resources (eg, cost, time, training, and computational power).
Conclusions: Using a convolutional neural network architecture, Consumabot consistently achieved good results in the classification of consumables and thus is a feasible way to recognize and register medical consumables directly to a hospital’s electronic health record. The system shows limitations when the materials are partially covered, therefore identifying characteristics of the consumables are not presented to the system. Further development of the assessment in different medical circumstances is needed.
Introduction: Injury prevention programs (IPPs) are an inherent part of training in recreational and professional sports. Providing performance-enhancing benefits in addition to injury prevention may help adjust coaches and athletes’ attitudes towards implementation of injury prevention into daily routine. Conventional thinking by players and coaches alike seems to suggest that IPPs need to be specific to one’s sport to allow for performance enhancement. The systematic literature review aims to firstly determine the IPPs nature of exercises and whether they are specific to the sport or based on general conditioning. Secondly, can they demonstrate whether general, sports-specific or even mixed IPPs improve key performance indicators with the aim to better facilitate long-term implementation of these programs?
Methods: PubMed and Web of Science were electronically searched throughout March 2018. The inclusion criteria were randomized control trials, publication dates between Jan 2006 and Feb 2018, athletes (11–45 years), injury prevention programs and included predefined performance measures that could be categorized into balance, power, strength, speed/agility and endurance. The methodological quality of included articles was assessed with the Cochrane Collaboration assessment tools.
Results: Of 6619 initial findings, 22 studies met the inclusion criteria. In addition, reference lists unearthed a further 6 studies, making a total of 28. Nine studies used sports specific IPPs, eleven general and eight mixed prevention strategies. Overall, general programs ranged from 29–57% in their effectiveness across performance outcomes. Mixed IPPs improved in 80% balance outcomes but only 20–44% in others. Sports-specific programs led to larger scale improvements in balance (66%), power (83%), strength (75%), and speed/agility (62%).
Conclusion: Sports-specific IPPs have the strongest influence on most performance indices based on the significant improvement versus control groups. Other factors such as intensity, technical execution and compliance should be accounted for in future investigations in addition to exercise modality.
Understanding and modulating CNS function in physiological as well as pathophysiological contexts remains a significant ambition in research and clinical applications. The investigation of the multifaceted CNS cell types including their interactions and contributions to neural function requires a combination of the state-of-the-art in vivo electrophysiology and imaging techniques. We developed a novel type of liquid crystal polymer (LCP) surface micro-electrode manufactured in three customized designs with up to 16 channels for recording and stimulation of brain activity. All designs include spare central spaces for simultaneous 2P-imaging. Nanoporous platinum-plated contact sites ensure a low impedance and high current transfer. The epidural implantation of the LCP micro-electrodes could be combined with standard cranial window surgery. The epidurally positioned electrodes did not only display long-term biocompatibility, but we also observed an additional stabilization of the underlying CNS tissue. We demonstrate the electrode’s versatility in combination with in vivo 2P-imaging by monitoring anesthesia-awake cycles of transgenic mice with GCaMP3 expression in neurons or astrocytes. Cortical stimulation and simultaneous 2P Ca2+ imaging in neurons or astrocytes highlighted the astrocytes’ integrative character in neuronal activity processing. Furthermore, we confirmed that spontaneous astroglial Ca2+ signals are dampened under anesthesia, while evoked signals in neurons and astrocytes showed stronger dependency on stimulation intensity rather than on various levels of anesthesia. Finally, we show that the electrodes provide recordings of the electrocorticogram (ECoG) with a high signal-to noise ratio and spatial signal differences which help to decipher brain activity states during experimental procedures. Summarizing, the novel LCP surface micro-electrode is a versatile, convenient, and reliable tool to investigate brain function in vivo.
Decoding the cellular network interaction of neurons and glial cells are important in the development of new therapies for diseases of the central nervous system (CNS). Electrophysiological in vivo studies in mice will help to understand the highly complex network. In this paper, the optimization of epidural liquid crystal polymer (LCP) electrodes for different platinum electroplating parameters are presented and compared. Constant current and pulsed current electroplating varied in strength and duration was used to decrease the electrode impedance and to increase the charge storage capacity (CSCc). In best cases, both methods generated similar results with an impedance reduction of about 99%. However, electroplating with pulsed currents was less parameter-dependent than the electroplating with constant current. The use of ultrasound was essential to generate platinum coatings without plating defects. Electrode model parameters extracted from the electrode impedance reflected the increase in surface porosity due to the electroplating processes.
Electrical stimulation is used for example to treat neuronal disorders and depression with deep brain stimulation or transcranial electrical stimulation. Depending on the application, different electrodes are used and thus different electrical characteristics exist, which have to be handled by the stimulator. Without a measuring device the user would have to rely on the stimulator being able to deliver the needed stimulation signal. Therefore, the objective of this paper is to present a method to increase the level of confidence with characterization and modelling of the electrical behavior by using the example of one channel of our stimulation device for experimental use. In several simulation studies with an electrode model with values in a typical range for cortical applications the influence of the load onto the stimulator and the possibility to pre-estimate measuring signals in complex networks are shown.
Disconnection in a left-hemispheric temporo-parietal network impairs multiplication fact retrieval
(2023)
Arithmetic fact retrieval has been suggested to recruit a left-lateralized network comprising perisylvian language areas, parietal areas such as the angular gyrus (AG), and non-neocortical structures such as the hippocampus. However, the underlying white matter connectivity of these areas has not been evaluated systematically so far. Using simple multiplication problems, we evaluated how disconnections in parietal brain areas affected arithmetic fact retrieval following stroke. We derived disconnectivity measures by jointly considering data from n = 73 patients with acute unilateral lesions in either hemisphere and a white-matter tractography atlas (HCP-842) using the Lesion Quantification Toolbox (LQT). Whole-brain voxel-based analysis indicated a left-hemispheric cluster of white matter fibers connecting the AG and superior temporal areas to be associated with a fact retrieval deficit. Subsequent analyses of direct gray-to-gray matter disconnections revealed that disconnections of additional left-hemispheric areas (e.g., between the superior temporal gyrus and parietal areas) were significantly associated with the observed fact retrieval deficit. Results imply that disconnections of parietal areas (i.e., the AG) with language-related areas (i.e., superior and middle temporal gyri) seem specifically detrimental to arithmetic fact retrieval. This suggests that arithmetic fact retrieval recruits a widespread left-hemispheric network and emphasizes the relevance of white matter connectivity for number processing.
Vibroarthrography measures joint sounds caused by sliding of the joint surfaces over each other. and can be affected by joint health, load and type of movement. Since both warm-up and muscle fatigue lead to local changes in the knee joint (e.g., temperature increase, lubrication of the joint, muscle activation), these may impact knee joint sounds. Therefore, this study investigates the effects of warm-up and muscle fatiguing exercise on knee joint sounds during an activity of daily living. Seventeen healthy, physically active volunteers (25.7 ± 2 years, 7 males) performed a control and an intervention session with a wash-out phase of one week. The control session consisted of sitting on a chair, while the intervention session contained a warm-up (walking on a treadmill) followed by a fatiguing exercise (modified sit-to-stand) protocol. Knee sounds were recorded by vibroarthrography (at the medial tibia plateau and at the patella) at three time points in each session during a sit-to-stand movement. The primary outcome was the mean signal amplitude (MSA, dB). Differences between sessions were determined by repeated measures ANOVA with intra-individual pre-post differences for the warm-up and for the muscle fatigue effect. We found a significant difference for MSA at the medial tibia plateau (intervention: mean 1.51 dB, standard deviation 2.51 dB; control: mean -1.28 dB, SD 2.61 dB; F = 9.5; p = .007; η2 = .37) during extension (from sit to stand) after the warm-up. There was no significant difference for any parameter after the muscle fatiguing exercise (p > .05). The increase in MSA may mostly be explained by an increase in internal knee load and joint friction. However, neuromuscular changes may also have played a role. It appears that the muscle fatiguing exercise has no impact on knee joint sounds in young, active, symptom-free participants during sit to stand.
Background: The extramuscular connective tissue (ECT) has been shown to play a significant role in mechanical force transmission between musculoskeletal structures. Due to this and owing to its tight connection with the underlying muscle, the ECT may be vulnerable to excessive loading. The present study aimed to investigate the effect of eccentric elbow flexor exercise on the morphology of the biceps brachii ECT. In view of the high nociceptive capacity of the ECT, an additional objective was to elucidate the potential relationship between ECT damage and the occurrence of delayed onset muscle soreness (DOMS).
Methods: Eleven healthy participants (♂ = 7; 24 ± 2 years) performed fatiguing dumbbell elbow flexor eccentric exercise (EE) for one arm and concentric exercise (CE) for the other arm in random order and with random arm allocation. Before, immediately after and 24–96 h post-exercise, maximal voluntary isometric contraction torque of the elbow flexors (dynamometer), pressure pain (algometer), palpation pain (100 mm visual analog scale), biceps brachii ECT thickness and ECT/muscle mobility during passive movement (both high-resolution ultrasound) were examined.
Results: Palpation pain, suggestive of DOMS, was greater after EE than CE, and maximal voluntary isometric contraction torque decreased greater after EE than CE (p < .05). Relative to CE, EE increased ECT thickness at 48 (+ 17%), 72 (+ 14%) and 96 (+ 15%) hours post-exercise (p < .05). At 96 h post-EE, the increase in ECT thickness correlated with palpation pain (r = .68; p < .05). ECT mobility was not different between conditions, but compared to CE, muscle displacement increased at 24 (+ 31%), 72 (+ 31%) and 96 (+ 41%) hours post-EE (p < .05).
Conclusion: Collectively, these results suggest an involvement of the ECT changes in delayed onset muscle soreness.
This scientific paper aimed to examine workplace stressors and factors influencing the Work-Life-Balance of nursing staff to understand potential factors and challenges. The Covid-19-pandemic has only again demonstrated the importance of sufficient and well-educated nursing staff. To ensure this, it is also important to consider the well-being of the nurses, because this influences their job performance, the turnover rate and the number of sick employees. To examine the workplace stressors and the Work-Life-Balance of nursing staff, different theoretical approaches and study findings are taken under consideration to determine their influence on the perceived stress of employees in general and nurses in particular and also the importance of a healthy Work-Life-Balance. The study was conducted by the Declaration of Helsinki and Tokyo. Many different factors make the job as a nurse potentially more stressful than for example administrative occupations. Moreover, there are plenty of difficulties for a healthy Work-Life-Balance for nursing staff and also potential negative effects resulting from a poor Work-Life-Balance or a high amount of workplace stressors. It can be concluded that a solution approach for the workplace stressors and a better Work-Life-Balance can only be reached if the employer and the employees work together to decrease the amount of stress, to offer and learn better mechanisms to cope with stress and to incorporate ways to ensure a better Work-Life-Balance.
Life-threatening cardiomyopathy is a severe, but common, complication associated with severe trauma or sepsis. Several signaling pathways involved in apoptosis and necroptosis are linked to trauma- or sepsis-associated cardiomyopathy. However, the underling causative factors are still debatable. Heparan sulfate (HS) fragments belong to the class of danger/damage-associated molecular patterns liberated from endothelial-bound proteoglycans by heparanase during tissue injury associated with trauma or sepsis. We hypothesized that HS induces apoptosis or necroptosis in murine cardiomyocytes. By using a novel Medical-In silico approach that combines conventional cell culture experiments with machine learning algorithms, we aimed to reduce a significant part of the expensive and time-consuming cell culture experiments and data generation by using computational intelligence (refinement and replacement). Cardiomyocytes exposed to HS showed an activation of the intrinsic apoptosis signal pathway via cytochrome C and the activation of caspase 3 (both p < 0.001). Notably, the exposure of HS resulted in the induction of necroptosis by tumor necrosis factor α and receptor interaction protein 3 (p < 0.05; p < 0.01) and, hence, an increased level of necrotic cardiomyocytes. In conclusion, using this novel Medical-In silico approach, our data suggest (i) that HS induces necroptosis in cardiomyocytes by phosphorylation (activation) of receptor-interacting protein 3, (ii) that HS is a therapeutic target in trauma- or sepsis-associated cardiomyopathy, and (iii) indicate that this proof-of-concept is a first step toward simulating the extent of activated components in the pro-apoptotic pathway induced by HS with only a small data set gained from the in vitro experiments by using machine learning algorithms.